Organization
MID-WILLAMETTE VALLEY TRANSGENDER SUPPORT NETWORK
Active
Other names
Mid Willamette Trans Support Network
Organization subpart
No
Provider details
NPI number
Authorized official
DHARMA LERIA MIRZA MA (GRANT & HEALTH PROGRAM COORDINATOR)
(541) 780-3307
Entity
Organization
Contact information
Practice address
260 SW MADISON AVE STE 110, CORVALLIS, OR 97333-4728
(541) 780-3307
Mailing address
260 SW MADISON AVE STE 110, CORVALLIS, OR 97333-4728
(541) 780-3307
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
251V00000X
Voluntary or Charitable Agency
—
—
261QR1100X
Research Clinic/Center
—
—
Other
Enumeration date
09/05/2024
Last updated
02/24/2025
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